What can we experience and report on a rapidly presented image? Intersubjective measures of specificity of freely reported contents of consciousness.

Background: A majority of previous studies appear to support a view that human observers can only perceive coarse information from a natural scene image when it is presented rapidly (<100ms, masked). In these studies, participants were often forced to choose an answer from options that experimenters preselected. These options can underestimate what participants experience and can report on it. The current study aims to introduce a novel methodology to investigate how detailed information participants can report after briefly seeing a natural scene image.     Methods: We used a novel free-report paradigm to examine what people can freely report following a rapidly presented natural scene image (67/133/267ms, masked). N = 670 online participants typed up to five words to report what they saw in the image together with confidence of the respective responses. We developed a novel index, Intersubjective Agreement (IA). IA quantifies how specifically the response words were used to describe the target image, with a high value meaning the word is not often reported for other images. Importantly, IA eliminates the need for experimenters to preselect response options. Results: The words with high IA values are often something detailed (e.g., a small object) in a particular image. With IA, unlike commonly believed, we demonstrated that participants reported highly specific and detailed aspects of the briefly (even at 67ms, masked) shown image. Further, IA is positively correlated with confidence, indicating metacognitive conscious access to the reported aspects of the image. Conclusion: These new findings challenge the dominant view that the content of rapid scene experience is limited to global and coarse gist. Our novel paradigm opens a door to investigate various contents of consciousness with a free-report paradigm.

How much can we differentiate at a brief glance: revealing the truer limit in conscious contents through the massive report paradigm (MRP).

Upon a brief glance, how well can we differentiate what we see from what we do not? Previous studies answered this question as 'poorly'. This is in stark contrast with our everyday experience. Here, we consider the possibility that previous restriction in stimulus variability and response alternatives reduced what participants could express from what they consciously experienced. We introduce a novel massive report paradigm that probes the ability to differentiate what we see from what we do not. In each trial, participants viewed a natural scene image and judged whether a small image patch was a part of the original image. To examine the limit of discriminability, we also included subtler changes in the image as modification of objects. Neither the images nor patches were repeated per participant. Our results showed that participants were highly accurate (accuracy greater than 80%) in differentiating patches from the viewed images from patches that are not present. Additionally, the differentiation between original and modified objects was influenced by object sizes and/or the congruence between objects and the scene gists. Our massive report paradigm opens a door to quantitatively measure the limit of immense informativeness of a moment of consciousness.

The implied motion aftereffect changes decisions, but not confidence.

Viewing static images depicting movement can result in a motion aftereffect: people tend to categorise direction signals as moving in the opposite direction relative to the implied motion in still photographs. This finding could indicate that inferred motion direction can penetrate sensory processing and change perception. Equally possible, however, is that inferred motion changes decision processes, but not perception. Here we test these two possibilities. Since both categorical decisions and subjective confidence are informed by sensory information, confidence can be informative about whether an aftereffect probably results from changes to perceptual or decision processes. We therefore used subjective confidence as an additional measure of the implied motion aftereffect. In Experiment 1 (implied motion), we find support for decision-level changes only, with no change in subjective confidence. In Experiment 2 (real motion), we find equal changes to decisions and confidence. Our results suggest the implied motion aftereffect produces a bias in decision-making, but leaves perceptual processing unchanged.

Third-Eye Rivalry.

We showcase an optical phenomenon that we call Third-Eye Rivalry. The effect is most easily induced by viewing one's own reflection in a mirror. Using the pupil of the opposing eye as a fixation target, people can easily cross their eyes in free fusion to experience vivid rivalry. The resulting percept is of a prominent central "third" eye and two peripheral faces rivaling for perceptual dominance. We illustrate the process of achieving third-eye rivalry and discuss historical connotations of the third eye in scientific and mystical contexts.

eStablish And Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) Electronic Delphi: Development of a Consensus Framework for Classifying and Reviewing Cardiac Arrests Within the PICU.

OBJECTIVES: To develop a consensus framework that can guide the process of classifying and reviewing pediatric in-hospital cardiac arrest in the PICU. DESIGN: A three-round electronic Delphi consensus study with an additional in-person session with pediatric resuscitation experts. The modified electronic Delphi consisted of survey questions sent to the expert panel with the goals of (1) achieving consensus on definitions of avoidable, potentially avoidable, and unavoidable PICU in-hospital cardiac arrest and (2) achieving consensus and ranking of a list of factors that contribute to potentially avoidable PICU in-hospital cardiac arrest. SETTING: Electronic surveys of resuscitation experts including pediatric critical care, cardiac critical care, emergency medicine, and hospital medicine physicians, nurses, advance practice nurses, and resuscitation researchers. PATIENTS: Not applicable. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Over three rounds of an electronic Delphi, 24 resuscitation experts participated. In Round 1, consensus was reached for the definitions of potentially avoidable and unavoidable cardiac arrest. Consensus was not reached for avoidable cardiac arrest. In Round 2, the expert panel agreed with seven factors from the literature and achieved consensus on an additional seven factors. Consensus was achieved on the modified definition of avoidable cardiac arrest. In Round 3, participants were asked to rank the contributing factors in order of their importance. For the in-person session, the consensus definitions and contributing factors from the modified electronic Delphi were presented to a multidisciplinary group of pediatric resuscitation experts and reached consensus for all three definitions. CONCLUSIONS: A multidisciplinary group of pediatric resuscitation experts generated a consensus-based framework to classify and review pediatric in-hospital cardiac arrest in the PICU. Future work will focus on the application of this framework and further validation of these definitions and contributing factors for in-hospital cardiac arrest both within and outside the PICU.

The Confidence Database.

Understanding how people rate their confidence is critical for the characterization of a wide range of perceptual, memory, motor and cognitive processes. To enable the continued exploration of these processes, we created a large database of confidence studies spanning a broad set of paradigms, participant populations and fields of study. The data from each study are structured in a common, easy-to-use format that can be easily imported and analysed using multiple software packages. Each dataset is accompanied by an explanation regarding the nature of the collected data. At the time of publication, the Confidence Database (which is available at https://osf.io/s46pr/) contained 145 datasets with data from more than 8,700 participants and almost 4 million trials. The database will remain open for new submissions indefinitely and is expected to continue to grow. Here we show the usefulness of this large collection of datasets in four different analyses that provide precise estimations of several foundational confidence-related effects.

Emergency Transfers: An Important Predictor of Adverse Outcomes in Hospitalized Children.

In-hospital arrests are uncommon in pediatrics, making it difficult to identify the risk factors for unrecognized deterioration and to determine the effectiveness of rapid response systems. An emergency transfer (ET) is a transfer from an acute care floor to an intensive care unit (ICU) where the patient received intubation, inotropes, or ≥3 fluid boluses in the first hour after arrival or before transfer. Improvement science work has reduced ETs, but ETs have not been validated against important health outcomes. This case-control study aimed to determine the predictive validity of an ET for outcomes in a free-standing children's hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).

Confidence as a diagnostic tool for perceptual aftereffects.

Perceptual judgements are, by nature, a product both of sensation and the cognitive processes responsible for interpreting and reporting subjective experiences. Changed perceptual judgements may thus result from changes in how the world appears (perception), or subsequent interpretation (judgement). This ambiguity has led to persistent debates about how to interpret changes in decision-making, and if higher-order cognitions can change how the world looks, or sounds, or feels. Here we introduce an approach that can help resolve these ambiguities. In three motion-direction experiments, we measured perceptual judgements and subjective confidence. We show that each measure is sensitive to sensory information and can index sensory adaptation. Each measure is also sensitive to decision biases, but response bias impacts the central tendency of decision and confidence distributions differently. Our findings show that subjective confidence, when measured in addition to perceptual decisions, can supply important diagnostic information about the cause of aftereffects.

An object-centered aftereffect of a latent material property: A squishiness visual aftereffect, not causality adaptation.

Visual aftereffects are characterized by a changed perceptual experience after exposure to a visual input. For instance, exposure to rightward motion can make a static input seem to drift leftward-the motion aftereffect. Such aftereffects have been integral to building our understanding of the neural mechanisms and computational processes that underlie perception. Increasingly complex characteristics have been found to be susceptible to visual aftereffects, such as the appearance of human faces, the apparent number of visual elements, and the glossiness of a surface. Here we report that the apparent elasticity, or squishiness, of an object is also subject to a visual aftereffect. This relationship can explain data previously interpreted in terms of a causality aftereffect.

Interpreting the temporal dynamics of perceptual rivalries.

Diverse forms of perceptual rivalry are claimed to tap a common causal mechanism. One of the bases for this claim is that the reported dynamics of binocular rivalry and motion-induced blindness are similar on an individual basis (Carter & Pettigrew, 2003 Perception, 32, 295-305). We examined this relationship and found no evidence for a strong correlation. We therefore question the proposition that the dynamics of diverse forms of rivalry are driven by a common mechanism.

Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events.

BACKGROUND AND OBJECTIVE: Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or ≥ 3 fluid boluses in first hour after arrival or before transfer. METHODS: The setting for our observational time series study was a quaternary care children's hospital. Before initiating tests of change, 2 investigators reviewed recent serious safety events (SSEs) and floor-to-ICU transfers. Collectively, 5 risk factors were associated with each event: family concerns, high-risk therapies, presence of an elevated early warning score, watcher/clinician gut feeling, and communication concerns. Using the model for improvement, an intervention was developed and tested to reliably and proactively identify patient risk and mitigate that risk through unit-based huddles. A 3-times daily inpatient huddle was added to ensure risks were escalated and addressed. Later, a "robust" and explicit plan for at-risk patients was developed and spread. RESULTS: The rate of UNSAFE transfers per 10,000 non-ICU inpatient days was significantly reduced from 4.4 to 2.4 over the study period. The days between inpatient SSEs also increased significantly. CONCLUSIONS: A reliable system to identify, mitigate, and escalate risk was associated with a near 50% reduction in UNSAFE transfers and SSEs.

Perceptions of stress, burnout, and support systems in pediatric bone marrow transplantation nursing.

Bone marrow transplantation (BMT) is used to treat various conditions, ranging from immune disorders to many types of cancer. The critical complexity of patients and the environment in which BMT nurses work can lead to stress, burnout, and, ultimately, poor retention. This study aimed to investigate nurses' perceptions of work-related stress and burnout as well as current support systems for nurses. The study included 30 BMT staff nurses from a large pediatric medical center in the midwestern United States. Critical illness or acuity of patients was reported as the most stressful factor; long work hours was the least stressful factor. Most nurses perceived moderate to high levels of emotional exhaustion, and 33% reported moderate levels of depersonalization. Fifty percent perceived high levels of personal accomplishment, despite the critical illness or acuity of their patients, demanding patient families, rotating shifts, short staffing, and caring for dying patients. Most nurses felt that support systems were in place and that staff was accessible, but most respondents were undecided about the helpfulness of the support systems. Results suggest that support systems may significantly affect work satisfaction and feelings of accomplishment for BMT nurses.